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. <br /> .� �c � y�y� � �yj+;F� �j r k ���4 � r�� �, ��pj <br /> �'"��k�:P:t���P���Y���y,Y;'ii��'".� �.t� .,._.�.,5±.��`h���:����.��J.++.i.���������3`-��'���' .st a_ �:-'4"�� sk�,�,°S�tu.�.1.. <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet / Floor Drains � <br /> f <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray / <br /> Shower Washer � <br /> Kitchen Sink J Water Heater f <br /> ( � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks � Miscellaneous <br /> ',�t` �: e �� -�.' " � ` � - r"- ,�,`+�'+' ��t�8 - 'kg`r�"��z n�ro' <br /> �'��u.c��d�,� �t-`��* 3 �° �"� � � �� u �� ������� '�,��-.;;�� �`'��r'^��.+�,�jd{' <br /> b� � x ' ���'�,'.' 3�a 3� d S� i'E`: <br /> r � + ��� � ��'� S� <br /> t <br /> ���� .-€ ����s� � ,� �. � � �s �` `. ,_ ...� �q ,�'2rh���`�;� r p3�� �� °,�� <br /> �.�., r�..� _.�- , J. ��.,. � <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. i <br /> Skip next section,if this applies; Cost of Pemrit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />